Review of Public Health Agency of Canada's Chronic Disease Indicator Framework.

The Public Health Agency of Canada (PHAC) has developed a Chronic Disease Indicator Framework that focuses on systematic and integrated chronic disease surveillance and provides the basis for consistent and reliable reporting on chronic diseases and their determinants. This comprehensive and focused pan-Canadian indicator framework for surveillance of chronic diseases and their determinants has been much anticipated to provide guiding principles for informing, planning, implementing, and monitoring regional chronic disease surveillance and prevention strategies. This article briefly reviews the Framework as published by PHAC, with some regional perspectives.

Developed through a structured, iterative, and consultative approach, the Framework and indicators are envisioned to contribute to an “early warning system” that could inform trends and become important resources for evidence-informed decision making in Canada. The indicators in the Framework cover much breadth in chronic diseases, including their determinants and outcomes, and for different stages of life. The set of 41 indicators is organized into six core domains: Social and environmental determinants (5 indicators); Early life/childhood risk and protective factors (3 indicators); Behavioural risk and protective factors (9 indicators); Risk conditions (5 indicators); Disease prevention practices (7 indicators); and Health outcomes/status (12 indicators).

Indicators for birth weight, breastfeeding, and exposure to second-hand smoke are currently included in the “Early life/childhood risk and protective factors” domain. Many additional early experiences - including those in schools - help children and youth develop important life skills, including health practices that continue into adulthood. These can have tremendous impacts on health in later years. Therefore, early childhood development and youth health are two areas that merit further consideration to enhance the Framework and the indicator suite.

Examples of regional applications of the Framework include: highlighting areas requiring public health attention and action; monitoring progress of prevention and mitigation strategies; and maintaining some consistency in these processes. One drawback, however, is that while some indicator data sources may allow reporting at the regional/local level, some of the national databases from which other indicators in the Framework were developed do not allow geographic disaggregation below the provincial/territorial level. This may limit the Framework’s usefulness as an “early warning system” because emerging trends often first surface at the sub-provincial level. It is therefore recognized that identifying or creating coordinated and innovative data collection methods is key to regional applications of the Framework. Furthermore, as the related products of the Framework including data outputs, continue to develop, local and regional public health practitioners and policy makers may play increasingly important roles - providing input into the presentation of data that will inform meaningful interpretation of the results at the regional/local level.

In conclusion, the Framework is a welcome step towards integrated and enhanced regional/local level chronic disease surveillance, provided that further enhancements and regional adaptations are considered. It has the potential to inform a variety of projects and ultimately contribute to a comprehensive approach to chronic disease surveillance and upstream prevention in Canada. The gaps (including gaps in data and gaps in indicators) identified during the framework and indicator development process present ample opportunities for increasing collaboration among regional/local, provincial/territorial, and federal public health agencies, and strengthening chronic disease prevention capacity and infrastructure across the country. 

Reference: Betancourt M.T., Roberts, K.C., Bennett, T-L., Driscoll E.R., Jayaraman G., and Pelletier L. Spring 2014. Monitoring chronic diseases in Canada: the Chronic Disease Indicator Framework. Chronic Diseases  in Canada. 34:Supplement.